Anxiety Mediates the Link Between Psychopathy and Aggression in NGRI Acquittees

• Date: 01 June 2021
• Author: Salpi Kevorkian,Elizabeth M. A. Wheeler,Carla Galusha,Lindsay Ingram,Nicholas D. Thomson
• Published date: 01 June 2021
• DOI: 10.1177/0306624X21994067
• Subject Matter: Articles

https://doi.org/10.1177/0306624X21994067

International Journal of

Offender Therapy and

Comparative Criminology

2021, Vol. 65(8) 955 –972

© The Author(s) 2021

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DOI: 10.1177/0306624X21994067

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Article

Anxiety Mediates the

Link Between Psychopathy

and Aggression in NGRI

Acquittees

Nicholas D. Thomson1, Salpi Kevorkian1,

Carla Galusha2, Elizabeth M. A. Wheeler3,

and Lindsay Ingram4

Abstract

Psychopathy has been long associated with anxiety, and anxiety has been argued

to play an important role in psychopathy-related behaviors, such as aggression.

However, these associations have not yet been explored in Not Guilty by Reason

of Insanity (NGRI) Acquittees. The goals of the present study were to test

the correlations between the 4-facet psychopathy construct and anxiety, and

to assess whether anxiety mediates the association between psychopathy and

aggression. In a sample of 81 NGRI acquittees, anxiety was positively related to

the lifestyle facet. When testing the mediating role of anxiety on the psychopathy-

aggression link, the results showed that low anxiety mediated the link between

the interpersonal facet and aggression. By contrast, high anxiety mediated the link

between the lifestyle facet and aggression. These results highlight the disparate

associations between specific psychopathy features and anxiety in predicting

aggressive behavior. The present findings demonstrate that violence reduction

strategies may need to become more tailored to individual needs when it comes

to reducing risk among people with varying levels of psychopathic traits and

serious mental illness.

1Virginia Commonwealth University, Richmond, USA

2Eastern State Hospital, Williamsburg, VA, USA

3Bay Forensic Psychology, Norfolk, VA, USA

4Oregon State Hospital, Salem, OR, USA

Corresponding Author:

Nicholas D. Thomson, Division of Acute Care Surgical Services, Departments of Surgery and Psychology,

Virginia Commonwealth University Health, West Hospital, Richmond, VA 23298, USA.

Email: Nicholas.Thomson@VCUHealth.org

994067IJOXXX10.1177/0306624X21994067International Journal of Offender Therapy and Comparative CriminologyThomson et al.

research-article2021

956 International Journal of Offender Therapy and Comparative Criminology 65(8)

Keywords

psychopathy, aggression, anxiety, NGRI, inpatient, serious mental illness, violence

Introduction

Psychopathy is one of the costliest psychiatric disorders, with cost-estimate studies

indicating psychopathy results in $460 billion in annual costs (Kiehl & Hoffman,

2011). A significant proportion of this cost is due to dangerous and violent behavior.

Psychopathic individuals are career criminals who engage in chronic violence over

their lifetime, regardless of being imprisoned or receiving treatment in the forensic

inpatient setting (Thomson, Vassileva, et al., 2019). Once released from prison or

treatment facilities, these individuals are more likely to continue to engage in aggres-

sive behavior (Grann et al., 1999; Gray & Snowden, 2016; Hemphill et al., 1998).

Further, prior research has found that violent psychopathic individuals are more

gratuitously violent (e.g., overkill), cruel, and sadistic (Juodis et al., 2014; Robertson

& Knight, 2014), and engage in non-discriminant and opportunistic aggression

(Pajevic et al., 2017; Porter et al., 2003). In an effort to break the cycle of violence,

researchers have advocated that psychopathy treatment strategies should focus on

risk-reduction rather than all efforts focusing on reducing personality traits

(Thomson, 2019 p. 148). After all, it is not illegal to be an unpleasant person, but it

is clearly illegal to cause harm to others (Sewall & Olver, 2018 p. 2). In an effort to

help break the cycle of violence, researchers are exploring mediators linking psy-

chopathy to aggression. This is an ambitious effort, but if mediators are identified

and these are malleable to interventions, we could see a substantial reduction in

aggression as psychopathic individuals, who make up about 1% of the general popu-

lation (Hare & Neumann, 2008), are responsible for 20% to 40% of all violent crimes

(Coid & Yang, 2011). Thus, targeting a small percentage of the population could

yield significant reductions in aggression.

Psychopathy and Aggression

Clinical assessment of psychopathy using the Psychopathy Checklist-Revised (Hare,

2003) originally included two broad factors, with factor 1 (also termed the interper-

sonal-affective factor) and factor 2 (also termed the impulsive-antisocial factor). These

factors can be further split into facets, with factor 1 consisting of the interpersonal (i.e.,

grandiosity, manipulative, superficial charm, and pathological lying) and affective fac-

ets (i.e., shallow affect, lack of remorse, callous lack of empathy, and failure to accept

responsibility). While factor 2 includes the lifestyle (i.e., need for stimulation, para-

sitic lifestyle, impulsivity, lack of long-term goals, irresponsibility) and antisocial fac-

ets (i.e., poor behavioral controls, early behavior problems, juvenile delinquency,

revocation of conditional release, and criminal versatility). The PCL-R’s interpersonal,

affective, and lifestyle facets share some overlapping features with other models of

psychopathy, such as the Triarchic Psychopathy Measure (Boldness, Meanness, and

Disinhibition, respectively).